All or nothing on Medicaid expansion

“Consistent with the law, there is not an option for enhanced match for a partial or phased in Medicaid expansion,” acting Center for Medicare and Medicaid Services administrator Marilyn Tavenner told reporters on a call Monday.

The administration’s reasoning goes like this: The federal government was giving states a really, really good deal on the Medicaid expansion. It was footing the entire bill for the newly eligible enrollees for three years. To put that in context, the feds usually chip in about half or two-thirds of a state’s Medicaid costs.

Congress, White House officials say, gave states that really high funding in the service of a very specific goal: Ensuring all Americans have access to insurance options.

“The law contemplated that every American would have a way to get health insurance coverage,” says Medicaid administrator Cindy Mann. “The Medicaid expansion to 133 percent was a method identified in the law to do that.”

States that don’t expand all the way up to that level, Mann contends, wouldn’t be complying with the spirit of the law. They wouldn’t offer all their residents a way to purchase affordable coverage. And if they’re not going to do that, White House says they don’t deserve the extra funding.

“The statute contemplates, with the enhanced match, that states will fully comply with the provisions of the law,” Mann says.

What this means for Texas is that any talk about counties doing Medicaid expansion on their own is now officially a non-starter. There wasn’t much momentum for that anyway, just some talk that mostly came from Bexar County, but now it no longer matters. Until such time as the state of Texas gets on board with full Medicaid expansion, we will continue to lead the nation in the number of uninsured residents, and we will do serious damage to public hospitals unless the Lege decides to fill the $2 billion hole that the feds will no longer cover but that Medicaid expansion was supposed to deal with. I’m not holding my breath for either of them to happen. Nothing will change until our leadership changes.